Consultants sent in to tackle overspending at nine ICSs

The external firms will be given a remit to identify interventions to “rapidly improve the in-year [2024-25] run rate”, according to documents seen by HSJ.

The ICSs in the “investigation and intervention” programme are:

• Black Country
• Cheshire & Merseyside
• Greater Manchester
• Lancashire & South Cumbria
• Mid & South Essex
• Nottingham & Nottinghamshire
• Shropshire, Telford & Wrekin
• South East London
• South Yorkshire

In May, NHSE overhauled the financial regime and introduced a new system of nationally set “control total” financial targets, backed by capital incentives and penalties, in a bid to bring down a forecast national gap of close to £3bn.

The national body has said no extra funding will be provided and all systems must hit the plans they submitted on 12 June. All but two ICSs are thought to have signed up for the new targets they were given.

Several sources said the net deficit planned across all ICSs was now around £2.2bn, a figure NHSE has not disputed. However, with systems and trusts already falling behind their plans and many based on huge efficiency saving targets, the year-end figure is widely expected to be much larger.

The new intervention at the nine systems is understood to be based on their month two (June) financial performance, which indicated they were at the highest risk of not meeting their full-year plans.

They have been mandated to appoint the consultancy, but the scope of the work carried out can be adjusted by each ICS to take account of local circumstances.

The first phase of the programme is to be completed within four weeks, with the supplier reporting to an NHSE-nominated leader who will “oversee and challenge both the work delivered, and the system itself”, according to a specification seen by HSJ.

Expected areas for review include financial controls, weaknesses within plans and “trends and key areas of growth” in pay spending.

In the second phase, which will take 12 weeks, the consultants will support the system to implement their recommendations. This could include non-clinical workforce controls as well as reviews of medical and nurse staffing.

The ICSs named above were approached for comment.

A spokeswoman for South East London ICS said: “We remain in discussion with NHSE regarding our financial position.”

An NHSE spokesman said: “We are supporting nine ICBs to review their finances and take steps to ensure they achieve a position consistent with their submitted plans for the year.”